Effect of orlistat on plasma lipids and body weight: A systematic review and meta-analysis of 33 randomized controlled trials

•Orlistat is an inhibitor of intestinal lipase promoting body weight reduction, but whose lipid-lowering efficacy is controversial.•We investigated the efficacy of orlistat on plasma lipids and body weight in a meta-analysis of 33 studies including 9732 participants.•Orlistat was associated with a slight but significant decrease in body weight, plasma cholesterol and triglyceride concentrations, whereas plasma Lp(a) levels were not affected by orlistat treatment.•Greater body weight reduction and lower duration of orlistat treatment promoted more consistent plasma total- and LDL-cholesterol lowering.

Orlistat, an inhibitor of intestinal lipase, promotes body weight reduction. The lipid-lowering efficacy of orlistat is controversial and the effect of orlistat-induced body weight reduction on lipid changes has not been explored in meta-regression analyses. A systematic literature search was conducted to identify randomized controlled trials investigating the efficacy of orlistat on plasma total, low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides and lipoprotein(a) levels. Thirty-three studies were included in the meta-analysis (5522 and 4210 participants in the orlistat therapy and control groups, respectively). Orlistat reduced body weight (weighted mean difference: −2.12, p < 0.001), total-cholesterol (weighted mean difference: −0.30 mmol/L, p < 0.001), low-density lipoprotein cholesterol (weighted mean difference: −0.27 mmol/L, p < 0.001), high-density lipoprotein cholesterol (weighted mean difference: −0.034 mmol/L, p < 0.001) and triglyceride (weighted mean difference: −0.09 mmol/L, p < 0.001) concentrations, while no effect on lipoprotein(a) was observed. Total- and low-density lipoprotein cholesterol-lowering were associated negatively with duration of orlistat treatment and positively with body weight changes. In conclusion, Orlistat treatment slightly reduces cholesterol and triglyceride levels, but not lipoprotein(a) levels. Total- and low-density lipoprotein cholesterol levels reductions are more consistent in patients with greater body weight reduction and shorter duration of orlistat treatment.

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